Impact of Maternal Viral Suppression on Growth Patterns for HIV-Exposed Uninfected Infants in Kenya

Katherine Magerko; John Humphrey; Julia Songok; Beverly Musick; Joy Marsha Alera; Bett Kipchumba; Wycliffe Kosgei; Winfred Mwangi; Kara Yang; Ziyi Wools-Kaloustian; Megan S McHenry

doi:10.25259/IJMA_656

Impact of Maternal Viral Suppression on Growth Patterns for HIV-Exposed Uninfected Infants in Kenya

Int J MCH AIDS. 2024 Apr 22:13:e005. doi: 10.25259/IJMA_656. eCollection 2024.

Authors

Affiliations

¹ Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States.
² Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States.
³ Department of Pediatrics, Moi University College of Health Sciences, School of Medicine, Eldoret, Kenya.
⁴ Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, United States.
⁵ Department of Academic Model Providing Access to Healthcare, Moi Teaching and Referral Hospital, Eldoret, Kenya.
⁶ Department of Reproductive Health, Moi Teaching and Referral Hospital, Eldoret, Kenya.

Abstract

Background and objective: Children born to mothers living with human immunodeficiency virus (HIV) are at risk for poor health outcomes but data characterizing these associations are limited. Our objective was to determine the impact of maternal viral suppression on growth patterns and malnutrition for infants who are HIV-exposed but uninfected (HEU).

Methods: We conducted a retrospective cohort analysis of clinical data for infants who were HEU and their mothers (September 2015 - March 2019) in Kenya. Infants were stratified based on maternal viral suppression status (≥ or <1000 copies/mL); t-tests were used to compare groups. Growth indicators were evaluated with Chi-square, Fisher's exact, and area under the curve. Moderate-to-severe underweight status, stunting, and wasting were defined by weight-for-age (WFA), height-for-age (HFA), and weight-for-height (WFH), z-scores ≤2, and were used to define malnutrition. Multivariate logistic regression analyses were performed to evaluate potential associations with malnutrition indicators between WFH and HFA.

Results: Among 674 infants who were HEU, 48.7% were male and 85.0% had mothers who were virally suppressed. The median age at first and last clinic visits was 1.5 and 16.4 months, respectively. WFA and HFA z-scores over time differed by sex, and WFA and HFA differed based on maternal viral suppression (P < 0.05). Male infants had higher adjusted odds for stunted status, and as children aged, they had slightly increased odds of becoming underweight or stunted. Maternal viral suppression and timing of maternal antiretroviral therapy initiation in relation to the prevention of vertical transmission (PVT) enrollment did not significantly affect malnutrition indicators.

Conclusion and global health implications: Maternal viral suppression status was not associated with increased odds of more severe malnutrition indicators in children who were HEU. However, overall growth patterns over time, measured by z-scores of growth indicators, did differ based on maternal viral suppression status, and to a lesser degree, by gender.

Keywords: Kenya; Key and Vulnerable Populations; Low- and Middle-Income Countries; Viral Load Monitoring; Viral Suppression.